Comparison Of Histomorphology, Angiogenesis and Proliferation in Kappa and Lambda Restricted Plasma Cell Myelomas with Its Effect on Prognosis

Aims Of the Study: To study the type of light chain restriction and correlate it with the morphological parameters, proliferation index, angiogenesis and clinical parameters. Materials And Methods: The study includes 46 cases of myeloma diagnosed over the period of five years. The histomorphological features like plasma cell morphology, percentage of plasma cells and pattern of infiltration were studied. Immunohistochemistry for kappa and lambda light chains was done. Angiogenesis was assessed by calculating the microvessel density (MVD) using anti CD34 immunohistochemistry. Proliferation was assessed immunohistochemically using Ki67 by comparing with anti CD38 which was used to highlight the plasma cells. Results: The cases with kappa light chain restriction had significantly less of poorly differentiated morphology (7.4% vs 36.8%; p=0.02) and diffuse pattern of infiltration (22% vs 63%; p=0.01) compared to lambda. The kappa group also had lower MVD (9.9 vs 16.5; p=0.02) and proliferation index (4.7 vs 94; p=0.04) compared to the lambda. Conclusion: Therefore, the type of light chain restriction is also a prognostic factor in plasma cell myeloma.